Malignant syphilis with presumed multifocal osteomyelitis in a patient with human immunodeficiency virus: A case report.
Yuki Rikitake, Takeshi Kawaguchi, Chihiro Iwao et al.
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Case in brief
A 37-year-old man with HIV presented with fever, weight loss, and a generalized rash featuring ulcerative lesions. Initial rapid plasma reagin testing was negative, but subsequent testing showed seroconversion. Histopathology confirmed syphilis with spirochetes, and imaging revealed multifocal bone lesions indicative of osteomyelitis. The patient was treated with oral amoxicillin and probenecid, leading to significant clinical improvement.
What made this case unusual
The case highlights the presence of clinically silent bone involvement in malignant syphilis, detectable only through imaging, which is atypical for this condition.
Diagnostic / clinical pearl
Clinicians should consider the possibility of malignant syphilis in HIV patients presenting with systemic symptoms and atypical skin lesions, even in the absence of bone pain.
Why it matters
This case illustrates the need for heightened awareness of malignant syphilis and its potential for systemic involvement, emphasizing the importance of imaging in diagnosis.